Surgical Outcomes among Focused versus Diversified Cataract Surgeons

Area of Science:

• Ophthalmology
• Surgical Outcomes
• Public Health

Background:

• Narrow surgical specialization is increasing in ophthalmology.
• Previous research on the impact of surgical focus on cataract surgery outcomes is limited.
• Understanding this relationship is crucial for patient safety.

Purpose of the Study:

• To determine if surgeons' exclusive focus on cataract surgery impacts the risk of adverse events.
• To compare outcomes between exclusive, moderately diversified, and highly diversified cataract surgeons.
• To inform surgical practice guidelines and patient counseling.

Main Methods:

• Population-based cohort study of 1,101,864 cataract surgeries in Ontario, Canada (2002-2013).
• Categorized surgeons into exclusive, moderately diversified (1-50% non-cataract), and highly diversified (>50% non-cataract) groups.
• Analyzed a composite outcome of 4 adverse events (posterior capsule rupture, dropped lens fragments, retinal detachment, endophthalmitis), controlling for patient, surgeon, and institutional factors.

Main Results:

• Adverse event rates were 0.73% (exclusive), 0.78% (moderate), and 2.31% (high diversification).
• No significant difference in adverse events between exclusive and moderately diversified surgeons (OR 1.08, 95% CI 1.00-1.18).
• Highly diversified surgeons showed a significantly higher risk of adverse events (OR 1.52, 95% CI 1.09-2.14), with a number needed to harm of 64.

Conclusions:

• Exclusive focus on cataract surgery is not associated with increased risk compared to moderate diversification.
• Surgeons with highly diversified practices (>50% non-cataract procedures) have a higher risk of cataract surgery adverse events.
• Surgical focus may be an important factor in optimizing cataract surgery safety.